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Osteoporosis Prevention in Inhaled Cortico -steroid Users

Osteoporosis Prevention in Inhaled Cortico -steroid Users. Principle Investigators: Hoan Linh Banh, Pharm.D Andrew Cave, MBChB MClSc Valerie Chan, BScPharm ACFP:ASA Banff Feb27th 2014. Conflicts of Interest.

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Osteoporosis Prevention in Inhaled Cortico -steroid Users

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  1. Osteoporosis Prevention in Inhaled Cortico-steroid Users Principle Investigators: Hoan Linh Banh, Pharm.D Andrew Cave, MBChBMClSc Valerie Chan, BScPharm ACFP:ASA Banff Feb27th 2014

  2. Conflicts of Interest • DrBanh and Ms Chan have no conflicts to declare • Dr Cave has received research support from GSK, Astra-Zeneca, Novartis. Merck Canada, Grifols, Boeringer-Ingelheim but has no conflict related to this study

  3. Introduction • Inhaled corticosteroids (ICS): • standard maintenance therapy in controlling symptoms in asthma patients • and add on in moderate to severe chronic obstructive pulmonary disease (COPD) • Risk of osteoporosis with systemic corticosteroid use is well known but there is low awareness of risk with ICS

  4. GINA Guidelines Patients on (1) High doses ICS (defined as >2 mg beclomethason/day) OR (2) Oral glucocorticosteroids(any dose) are considered at risk of developing osteoporosis and fractures.

  5. Osteoporosis Prevention • Calcium supplementation • Age 19-50: 1000 mg/day • Age >50: 1200 mg/day • Vitamin D supplementation • Age <50: 400 IU/day • Age >50: 800-2000 IU/day • Lifestyle Modifications • Smoking Cessation • Exercise • Limit alcohol intake

  6. Objectives • Primary: To investigate the extent of osteoporosis prevention or treatment received by patients with asthma and COPD treated with ICS. • Secondary: To assess the number of patients, regardless of ICS dose, who met the requirements for an initial BMD scan, received the BMD and received appropriate follow up when indicated.

  7. Methodology • Inclusion: • Age ≥19 years • ICS use ≥ 3 months in the past 12 months • Willing to answer a questionnaire • Exclusion: • Difficulty speaking English or cognitively impaired

  8. Results • N = 255 • Overall mean age = 60 years (SD = 17.4 years) • 66% Female – mean age 61 (SD = 17.1 years) • 34% Male – mean age 57 (SD = 17.7 years)

  9. Results

  10. Results

  11. Results

  12. Results

  13. Results

  14. Results Summary • Subjects are more than twice as likely to take appropriate vitamin D than calcium • Taking apprpriate Vitamin D and Calcium • Low ICS users = 19% • Medium ICS users = 21% • High ICS users = 8% • Having appropriate osteoporosis prophylaxis or being treated for OP • Low ICS users = 28% • Medium ICS users = 30% • High ICS users = 26%

  15. Results Summary 2 • 29% ofsubjects(73/255) were found to be sufficiently supplemented or treated, regardless of dose potency • Either by • adequate intake of both calcium and vitamin D (45 patients) • treated for osteoporosis (28 patients)

  16. Discussion • High dose ICS users: (at highest risk) • 62% ≥ 65 years old (age increases OP risk) • Had lowest appropriate intake of calcium at 13% (7/53) • ? Pill size issue, constipation in older age

  17. Discussion • BMD: • Majority of eligible subjects received an initial scan and appropriate follow up

  18. Discussion • Study Limitations and Difficulties • Health Information Act • Data may not represent all of Alberta • Restrictions imposed by pharmacy authority • Pharmacy settings with a low rate of returning patients • Subjective reporting • Some subjects could not recall exact year that they received follow up of BMD • Dietary intake of vitamin D and calcium hard to assess

  19. Conclusion • < 29% of patients are achieving appropriate osteoporosis prophylaxis or treatment regardless of ICS dose • high dose ICS users (highest need of osteoporosis prevention) have lowest prevention/treatment rate (26%) • For patients who qualified for an initial BMD test, 61% received it.

  20. Acknowledgements • Costco #544 – Sherwood Park, Alberta • Shoppers Drug Mart #302 – Edmonton, Alberta • Shoppers Drug Mart #312 – Edmonton, Alberta • Shoppers Drug Mart #346 – Edmonton, Alberta • Shoppers Drug Mart #386 – Edmonton, Alberta • Shoppers Drug Mart #2301 – Edmonton, Alberta • London Drugs #22 – Edmonton, Alberta • Safeway Capilano – Edmonton, Alberta • Sprucewood Pharmacy – Lloydminster, Alberta • Walmart #3118 – Edmonton, Alberta • Walmart #1570 – Camrose, Alberta • Walmart #7236 – Edmonton, Alberta

  21. Questions?

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